“The girls have a lot of empathy for vulnerable children in need of life-saving medical care,” Madonna says of their visits with her charity, Raising Malawi.

Madonna with daughters Estere (left) and Stella.Credit : Kevin Mazur/WireImage

Madonna is opening up about life with her youngest daughters.

The Queen of Pop added to her family in February 2017, when she adopted twin daughters Estere and Stella from an orphanage in Malawi.

Now 12, the girls have returned to their home country many times with their famous mom, who met them while doing work for her charity, Raising Malawi — and she’s giving a rare update on the twins.

“The girls have a lot of empathy for vulnerable children in need of life saving medical care,” Madonna, 66, tells PEOPLE exclusively of their travels back to Malawi with the nonprofit, “and they are very grateful to be living in a country where medical care is readily available for people.”

Estere and Stella visiting a baby and Jane, a house mother at Home of Hope, the orphanage in Lilongwe, Malawi, where Madonna met them; Jane took care of the twins when they were living there.Courtesy of Madonna

Madonna is also mom to adopted children David Banda and Mercy James, both 19, as well as daughter Lourdes Leon, 28, and son Rocco Ritchie, 24, from previous relationships.

Giving back has become a family affair for Madonna and her six children.

“We are so much closer because we have a common goal, and that is making Malawi a better country for kids to grow up,” Madonna says of their work with Raising Malawi.

Madonna’s kids Rocco, David Banda, Mercy James, Lourdes and twins Estere and Stella during a trip to Malawi.Courtesy of Madonna

The “Vogue” singer founded Raising Malawi in 2006 to improve the lives of children in the African nation. Eleven years later, she opened the Mercy James Centre, the first pediatric hospital in the country. On March 11, Madonna unveiled a new initiative that supporters to become Raising Malawi Partners. Partners can contribute any amount of money monthly to provide life-changing medical care at the Mercy James Centre, while receiving access to regular updates on the nonprofit’s work and behind-the-scenes content, as well as the chance to win merchandise and experiences. (Click here for more Raising Malawi Partners.)

After hosting PEOPLE at the 2017 opening of the Mercy James Hospital, Madonna opened up about what drew her to her adopted children in an exclusive cover story.

“It’s inexplicable,” Madonna said at the time. “It’s like saying, ‘Why do you fall in love with the people you fall in love with?’ You look into the eyes of somebody, you feel their soul, you feel touched by them — that’s it.”

Madonna with Dr. Eric Borgstein at the Mercy James Centre.Credit: Courtesy of Madonna

Madonna and Dr. Eric Borgstein with a patient at the Mercy James Center in Malawi.Credit: Courtesy of Madonna

Madonna visiting children in Malawi as part of her with with Raising Malawi.Credit: Courtesy of Madonna

After meeting the twins, Madonna had an epiphany: “Sometimes I would just close my eyes and just think, ‘Why isn’t my kitchen filled with dancing children?’ There’s so many children that need a home,” she had recalled. “I thought, ‘What am I waiting for? Just do it.’ ”

Estere and Stella returned to their home country and were on hand when Madonna opened the Mercy James Centre.

“They were really happy to be there and speak [the native language] Chichewa with everybody,” Madonna told PEOPLE afterward. “And they’ve learned, in time, that I’m their mother and nothing is going to change that.”

Over the years, Estere and Stella have joined their mom onstage — from her Madame X Tour in 2019, to a Pride performance in Brooklyn last year.